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Personality disorders elevate risk of substance abuse.

LOS ANGELES -- A new nationwide study has begun to shed light on the complex relationship between personality disorders, and substance use onset and dependence.

The odds of alcohol dependence, drug abuse / dependence, and nicotine dependence were elevated for people with any personality disorder in the National Epidemiologic Survey of Alcohol and Related Conditions (NESARC), a longitudinal study of more than 43,000 Americans, reported Deborah S. Hasin, Ph.D., professor of clinical public health at Columbia University, New York.

Dr. Hasin unveiled results of a selective analysis of substance use prevalence and persistence data from NESARC Waves 1 (2001-2002) and 2 (2004-2005) during a symposium at the annual meeting of the American Academy of Addiction Psychiatrists.

For example, she found that having any personality disorder based on DSM-IV diagnostic criteria increased the odds of meeting criteria for alcohol dependence more than sevenfold at an initial interview during Wave 1 of the study.

The highest baseline rates of alcohol dependence were among individuals with schizotypal personality disorder, dependent personality disorder, or borderline personality disorder, Dr. Hasin said at the annual meeting of the American Academy of Addiction Psychiatrists. The odds of drug abuse or dependence were elevated more than 13-fold for people with any personality disorder, 13.2, with the highest odds for current use seen among people with schizotypal (odds ratio, 13.2) or borderline personality disorders (see chart).

Nicotine dependence was nine times higher among people with personality disorders as other respondents.

People with schizotypal, borderline, or antisocial personality disorders who initially were identified as dependent on alcohol were at least twice as likely as others in the study to be persistently dependent 3 years later, even after adjusting for demographic factors and comorbid Axis I diagnoses.

The odds of chronic drug abuse also were elevated more than twofold for those with schizotypal or antisocial personality after adjustment.

The persistence of nicotine dependence was even more striking among people with personality disorders, with the odds among those with antisocial, borderline, obsessive/compulsive, and schizoid personality disorders elevated by 3.0, 2.0, 1.5, and 1.4, respectively, over other smokers interviewed in the study.

The study results might have implications for research, particularly with an eye toward substance abuse treatment modalities that might not be ideal for people with personality disorders, Dr. Hasin said.

Dr. Hasin's research and NESARC were government-funded studies. She reported no financial disclosures.
Patients With Personality Disorders Are at Increased
Risk For Substance Dependence

                            Alcohol     Drug abuse/    Nicotine
                           dependence   dependence    dependence

Any personality disorder      7.3          13.2          9.3
Antisocial                    3.5           4.4          2.7
Borderline                    5.1          10.0          4.8
Dependent                     5.5           5.2          3.8
Schizotypal                   7.3          13.2          9.3

Note: Odds ratios based on a 4-year longitudinal interview study of
more than 40,000 individuals with personality disorders.

Source: Dr. Hasin
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Title Annotation:MENTAL HEALTH
Author:Bates, Betsy
Publication:Family Practice News
Article Type:Clinical report
Date:Jan 1, 2010
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